MEDICARE: MARISA J COVERT MT-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225A00000X	Music Therapist	07527

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07527	OTHER		CERTIFICATION FOR MUSIC THERAPISTS

General Provider Information

NPI Number	:	1275760597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA J COVERT MT-BC

Provider Business Mailing Address
First Line	:	3225 E BASELINE RD
Second Line	:	#1032
City	:	GILBERT
State	:	AZ
Zip	:	85234-2677
Country	:	US
Telephone Number	:	480-201-6163
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 E BASELINE RD
Second Line	:	#1032
City	:	GILBERT
State	:	AZ
Zip	:	85234-2677
Country	:	US
Telephone Number	:	480-201-6163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2009
Last Update Date	:	06/12/2009

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Directions to “ MARISA J COVERT MT-BC” Practice Location

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